Prof John Windsor

Hernia

There are many types of hernia.

A hernia develops because of a weakness in the abdominal wall that allows the protuberance of fat and/or bowel which is contained in a sac of the inner lining of the abdominal cavity (peritoneum). The weakness might have been present for many years or might have developed with age or after failure of a surgical wound (incisional hernia). The risks are that small bowel can enter the sac and become trapped, causing bowel obstruction and/or perforation.

Certain factors such as chronic constipation, chronic coughing, obesity, and an enlarged prostate may increase the risk of developing a hernia.

Patients with hernias usually notice that the lump is more prominent when active. And the symptoms of abdominal pain, nausea and vomiting are more common with standing or lifting heavy objects.

Virtually all hernias need to be surgically repaired. The principle is the same for all hernias. The peritoneal sac needs to be identified and separated from surrounding tissue, opened and the contents reduced back into the abdomen, tied off and the sac removed, and then repair of the weakness in the abdominal wall. This repair can be done by just closing the edges together with strong stitches or by using an artificial mesh to bridge the defect. The mesh can be laid inside the defect or on the outside. Both traditional open and laparoscopic approaches are widely used. The operation is finished by closing the fat and skin layers.

Inguinal hernia

This is a common type of hernia, especially in men. It often develops as a result of strenuous activity and becomes uncomfortable and is often associated with a bulge or lump in the groin area. Sometimes the hernia can be come very large and descend into the scrotum. The treatment for inguinal hernia is surgery. A truss, advocated by some, is not advised. Surgery can be performed from the front (open hernia repair) or with more extensive dissection from behind using laparoscopic methods (laparoscopic hernia repair). Both are effective, and both use mesh. Despite what enthusiasts for laparoscopic hernia repair wills say, the evidence shows that there is very little difference between the two approaches. The alternatives will be discussed.

Epigastric hernia

There is a natural line of weakness in the upper midline of the abdomen and this is where epigastric hernias develop. The principles of surgical repair are similar.

Umbilical and para-umbilical hernias

Another area of weakness is in and around the umbilicus (tummy button). The principles of repair are similar.

Incisional hernia

Incisional hernia occurs because of the failure of the scar from a previous previous surgical incision made in the abdomen. They are more common after infection of the previous incision and in obese or pregnant patients. Incisional hernias can be very small or large and there are several repair options that will be discussed.

Femoral hernia

Femoral hernias more commonly develop in women and older patients. The defect is below the inguinal region.

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